General risks from the creation of the pneumoperitoneum and possibly an adhesiolysis: injuries to vessels and hollow organs are possible during blind insertion with the Veress needle, but also with the optical trocar. In previously operated patients, however, preference should be given to the optical trocar.
During adhesiolysis, thermal damage to the intestinal wall must be considered and safely excluded.
If laparoscopic visualisation is not achievable, immediate conversion to open surgery.
Additional working trocars should always be placed under direct vision in order to avoid intra-abdominal injuries.
Bleeding:
- The epigastric vessels should be noted; bleeding from the trocar insertion sites is preferably managed with U-sutures using suture aids for fascia closure.
- Bleeding from the staple line -> oversewing or clipping
- Bleeding from retroperitoneal vessels (vena cava or aorta)
- Bleeding from the omentum
- -> If laparoscopic visualisation cannot be achieved, immediate open surgery. The risk of injury to the retroperitoneal vessels is increased by adhesions.
Injury to Adjacent Organs:
- Spleen: compression, haemostatics, thermal methods, as a last resort -> splenectomy
- Parenchymal tears of the liver caused by the retractor -> haemostasis with monopolar current, compression, haemostatics (see Medical Equipment tab)
- Injury to the pancreas -> oversewing, target drainage
- Injury to the oesophagus by the large-calibre gastric tube: endoscopic approach with endo-clips in combination with epinephrine injection.
Too Short Alimentary Limb:
Not to be expected due to the primarily sleeve-like pouch form; possibly retrocolic elevation.
Loop Rotation:
To avoid loop rotation ("blue loop syndrome"), the loop is brought up under direct vision (mesentery facing left). If rotation nevertheless occurs, it is released and corrected.